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Clinical Investigations: CARDIOLOGY |

Echocardiographic Predictors of an Adverse Response to a Nifedipine Trial in Primary Pulmonary Hypertension*: Diminished Left Ventricular Size and Leftward Ventricular Septal Bowing

Mark J. Ricciardi, MD; Eduardo Bossone, MD, PhD; David S. Bach, MD; William F. Armstrong, MD; Melvyn Rubenfire, MD
Author and Funding Information

*From the Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI.

Correspondence to: Melvyn Rubenfire, MD, University of Michigan Health System, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48106-0363; e-mail: Mrubenfi@umich.edu



Chest. 1999;116(5):1218-1223. doi:10.1378/chest.116.5.1218
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Background: The clinical course in primary pulmonary hypertension (PPH) is improved by calcium channel blocker therapy in those with a favorable hemodynamic response during a trial of high-dose oral nifedipine. Although trials of nifedipine are performed only in patients who demonstrate pulmonary vasodilator reserve to short-acting agents, this response does not predict the safety of nifedipine treatment, which can result in severe first-dose hypotension and death.

Study objectives: To identify echocardiographic parameters that predict first-dose nifedipine-induced hypotension in patients with PPH.

Methods: The pretrial echocardiograms of 23 consecutive PPH patients (mean age, 42.3 ± 13 years; 77% female) undergoing evaluation of pulmonary vasodilator reserve with nifedipine were analyzed. Patients were classified as those who suffered first-dose nifedipine hypotension (group 1) and those who did not (group 2). Echocardiographic measures of chamber size and septal geometry in the two groups were compared.

Results: Five measures reflecting diminished left ventricular (LV) size and leftward ventricular septal bowing were found to be associated with nifedipine hypotension: LV transverse diameter in systole (LVDs; p = 0.007), LV transverse diameter in diastole (LVDd; p = 0.05), LV area in systole (LVAs; p = 0.009), LV area in diastole (LVAd; p = 0.03), the ratio of RV to LVAs (p = 0.02), and leftward ventricular septal bowing (p = 0.01). The LV dimensions found to best predict nifedipine-induced hypotension were LVDs < 2.7 cm, LVDd < 4.0 cm, LVAs < 15.5 cm2, and LVAd < 20.0 cm2.

Conclusions: Readily available echocardiographic parameters in patients with PPH are predictive of nifedipine-induced hypotension, and can be used to select patients in whom a trial of nifedipine should be avoided.

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